title: Clinical value of myocardial perfusion scintigraphy as a screening tool in liver transplant candidates.
abstract: A cardiac evaluation before orthotopic liver transplantation (OLT) is imperative. Previous investigations have demonstrated that mild to moderate reversible perfusion defects on myocardial perfusion scintigraphy (MPS) in general are associated with a low risk for perioperative cardiac events. The objective of this study was to assess any perfusion defects in consecutive patients with chronic liver disease who were undergoing OLT. OLT candidates underwent extensive cardiovascular screening that included, among other methods, MPS. Patients who had no contraindications for surgery and underwent OLT were followed up. The occurrence and risk of complications and mortality were compared in 3 groups of patients: patients with normal MPS results, patients with any reversible defect, and patients with a fixed perfusion defect on MPS. In all, 156 subsequent patients underwent OLT. One or more reversible segmental perfusion defects on MPS were present in 14 patients (<3 segments, n = 12; 3 segments without obstructive coronary artery disease, n = 2). The risk of complications did not differ significantly between patients with normal MPS findings and patients with a reversible perfusion defect (odds ratio = 3.04, 95% confidence interval = 0.65-14.26, P = 0.16), although the study was not sufficiently powered to show a difference. The presence of 1 or more reversible defects on MPS was significantly associated with an increased incidence of all-cause 1-year mortality (hazard ratio = 3.17, 95% confidence interval = 1.02-9.83, P = 0.046). No significant difference in the outcomes of patients with normal MPS findings and patients with a fixed defect on MPS was found; the study was, however, not adequately powered to do so. In conclusion, the results of this small cohort study indicate that patients with mild to moderate reversible perfusion defects on MPS may have inferior survival characteristics in comparison with patients with normal MPS results. A prospective, adequately powered study is required to confirm the results of this study.
authors.affiliation: Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Daniela E
authors.initials: DE
authors.lastname: Oprea-Lager
authors.forename: Bastiaan J
authors.initials: BJ
authors.lastname: Sorgdrager
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Roderick W C
authors.initials: RW
authors.lastname: Scherptong
authors.forename: Jan
authors.initials: J
authors.lastname: Ringers
authors.forename: Minneke J
authors.initials: MJ
authors.lastname: Coenraad
authors.forename: Bart
authors.initials: B
authors.lastname: van Hoek
authors.forename: Marcel P M
authors.initials: MP
authors.lastname: Stokkel
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D055414:Myocardial Perfusion Imaging; D009426:Netherlands; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome